Healthcare Provider Details

I. General information

NPI: 1871986505
Provider Name (Legal Business Name): I & J PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11855 E SOUTH ST
CERRITOS CA
90703-6825
US

IV. Provider business mailing address

11855 E SOUTH ST
CERRITOS CA
90703-6825
US

V. Phone/Fax

Practice location:
  • Phone: 562-444-5545
  • Fax: 562-444-5560
Mailing address:
  • Phone: 562-444-5545
  • Fax: 562-444-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN PARK
Title or Position: CEO
Credential: PHARM.D.
Phone: 562-547-1799